Why is the practice changing its appointment system?
The staff at East Parade Surgery, along with NHS England (NHSE), have acknowledged the increasing demand for appointments and our capacity being unable to meet this demand. NHSE has recently published a paper (Delivery plan for recovering access to primary care) outlining their similar concerns.
There are not enough GP appointments nationally to meet increased patient demand so we are needing to ensure only those who need to see a GP will get an appointment. What a patient may ‘want’ is not the same as what they ‘need’. Many conditions can be managed by non-GP clinicians – this includes physiotherapists, pharmacists, mental health workers, social prescribers, and other members of the team.
The NHS system is complex to navigate, and we recognise patients need help with this.
Total Triage has been designed to ensure that patients who most need an appointment are able to get one, and to facilitate equity of access to care.
We understand how frustrating it can be for patients to wait in phone queues to get an appointment. We have also noticed that many patients are booking appointments that do not necessarily require one, and we are concerned that those who need to be seen are not getting seen at the right time.
NHSE has stated that there is good evidence that clinician triage and modern online tools make it easier to manage patient requests and involve the wider team, with higher patient satisfaction rates than with the more traditional model.
To address this issue, we are introducing a Total Triage Model of care. This means that anyone requesting an appointment or advice will have their request triaged. Our online consultation forms provide us with key information about your problem, so that we can arrange an appointment at the right time with the right person – if needed.
GO LIVE DATE: Monday 16th September 2024
What is Total Triage?
- It’s a new system that involves a GP providing support to our Care Navigators to triage all appointment requests before an appointment is given.
- This means that the GP will determine how quickly an appointment is needed and whether your request would be better dealt with by another member of our multi-disciplinary clinical team or by another service.
We understand that change can be difficult, but we believe that this new approach will ensure that patients’ needs are met safely and efficiently. We are committed to delivering a robust service to our patients, and we believe that this new strategy will help us achieve this goal.
How do I send an online consultation?
Online consults can be submitted via the NHS App or our website.
If you have any issues submitting an online consult, our care navigators in our patient services team can assist in completing this.
Online eConsult System
- To make Patient Triage more efficient, we will be expanding the use of our existing online consult system ‘eConsult’. Our online consult system is accessible to everyone, with no need to download an app or log in. All you need is access to the internet, and you can access the system from any device, including your smartphone or tablet. Simply visit our website.
- Your completed form will be sent to our triage hub, meaning that your appointment request will be triaged promptly, and you will receive a response from us in a timely manner.
- Many of you will be familiar with this process already, but until now we have only been able to offer limited capacity to process eConsults, so the facility is not always available.
- With the new appointment system, this will be the main route for accessing appointments with GPs and other health professionals within the surgery (but please note that before 16th Sept the eConsult capacity remains capped, so please continue to contact the surgery in your usual way, until we ‘go live’ with this)
- The Total Triage service will have a staggered opening time to cope with demand and allow us to safely manage the number of patients we can consult with on a daily basis. You will not be able to send your GP a Total Triage form over the weekend, when you should instead contact the NHS 111 service. NHS 111 will put you in touch with the out of hours doctor if your problem needs GP assistance over the weekend.
What if I have trouble using the new system?
- We hope to support patients and their families/carers to get used to the new way of contacting the practice and to become comfortable with this over time.
- We will, of course, provide additional support to those patients who are unable to use online resources.
- If you do not have on-line access, or experience other difficulties using digital technology, please speak to our patient services team about how we can help you.
How will the practice respond?
- If an appointment is necessary, you will be sent an electronic link to make either a priority or routine GP appointment (depending upon the GP’s assessment of the urgency of your condition).
- Please be reassured that those with problems requiring a more urgent response will be identified by eConsult, and contacted urgently, if an on the day appointment is needed.
- In some cases, we will be able to arrange necessary tests / investigations prior to your appointment, to maximise the value of your appointment.
- We can arrange an appointment with one of our allied health professionals, such as our Nursing Team, Clinical Pharmacists, Social Prescriber, First Contact Musculoskeletal Specialists, or First Contact Mental Health Practitioner.
- You may be directed to a Community Pharmacy.
- You may be given advice via text message or email.
What else can I do online?
- You can also complete eConsultations for medication reviews and administrative queries such as referrals and Fit notes. These will be directed to the appropriate team.
- Repeat Medication requests should continue to be ordered using SystmOnline, or the NHS App, and not directed through eConsult.
- Test Results can be viewed via the NHS App or SystmOnline
- Self-Care Advice can be access through the eConsult portal, NHS App and NHS website
What if I have trouble using the new system?
- We hope to support patients and their families/carers to get used to the new way of contacting the practice and to become comfortable with this over time.
- We will, of course, provide additional support to those patients who are unable to use online resources.
- If you do not have on-line access, or experience other difficulties using digital technology, please speak to our patient services team about how we can help you.
How will the practice respond?
- If an appointment is necessary, you will be sent an electronic link to make either a priority or routine GP appointment (depending upon the GP’s assessment of the urgency of your condition).
- Please be reassured that those with problems requiring a more urgent response will be identified by eConsult, and contacted urgently, if an on the day appointment is needed.
- In some cases, we will be able to arrange necessary tests / investigations prior to your appointment, to maximise the value of your appointment.
- We can arrange an appointment with one of our allied health professionals, such as our Nursing Team, Clinical Pharmacists, Social Prescriber, First Contact Musculoskeletal Specialists, or First Contact Mental Health Practitioner.
- You may be directed to a Community Pharmacy.
- You may be given advice via text message or email.
What else can I do online?
- You can also complete eConsultations for medication reviews and administrative queries such as referrals and Fit notes. These will be directed to the appropriate team.
- Repeat Medication requests should continue to be ordered using SystmOnline, or the NHS App, and not directed through eConsult.
- Test Results can be viewed via the NHS App or SystmOnline
- Self-Care Advice can be access through the eConsult portal, NHS App and NHS website
How Does This Benefit me?
- We understand that change can sometimes be difficult, but we are confident that Total Triage will bring many benefits to you, our patients – for example:
- Improved Access to Care: Total Triage has been shown to reduce waiting times and it enables us to attend to your medical needs more promptly. By using remote consultations, where appropriate, we can free up face to face appointments for those patients that need them.
- Reduced time spent waiting on the telephone.
- Convenience: Using digital communication will mean that you can engage with us from the comfort of your home or workplace. No more having to travel to the practice and possible long waits for simple enquiries or prescription renewals. If you haven’t already, please download the NHS App or make your requests online by filling in an eConsult here https://eastparadesurgery.webgp.com/
- Enhanced Patient Experience: We are committed to providing you with the best possible care at East Parade Surgery. Total Triage improves communication and ensures that you see the person best able to help you, in a timely way.
- Embracing Innovation: As healthcare technology advances, we are committed to staying at the forefront of these innovations. Total Triage will enable us to adapt and evolve with the changing healthcare landscape and ensure that you benefit from the latest advances in medical care.
What next?
- We will be rolling out these changes gradually, and our team is here to guide and support you every step of the way. Should you have any questions or concerns, please do not hesitate to contact us.
- Our go live date is MONDAY 16th September.
- Thank you for working together with us on this new project to improve our patient access. We welcome your feedback and ideas moving forward.
Questions and Answers
We have tried to answer as many of the likely questions as we can below. Please do send us any more you may have so we can share (anonymously) with all our patients.
I don’t have access to a computer or phone – what do I do?
- We will always encourage you to see if someone can help you send an online request first. Often family members or friends can facilitate this. We do understand there are a small number of patients who are not able to.
- You can contact us by phone and our trained Patient services team will fill in a questionnaire on your behalf.
- This will be forwarded to the triaging GP and treated the same way as anyone sending in one online.
I am struggling to use the online system; can someone help me?
- Absolutely. We are keen to support our patients who need a bit of extra help.
- We have trained members of staff who can help you do this.
- We are hoping to set up some training sessions for patients and we will let you know how to access this.
Can I walk into the surgery to make an appointment?
- We strongly discourage patients from walking in to make an appointment. Primary care has never been an emergency service – if a patient needs immediate medical attention, you should ring 111 or go direct to A+E.
- If a patient walks in, they will be treated the same as anyone sending an online consult. The receptionist will ask you for details (following a questionnaire the GPs have designed). This will be added to the Triaging GP list to be assessed.
- It does NOT speed up your enquiry – we manage the requests based on a safety system.
Do I have to share personal information with a receptionist if I ring/walk-in?
- It is important you give us as much relevant information as possible so we can ensure your request is triaged properly.
- We understand some issues can be sensitive and we can use a private room if needed.
- Our Patient services team are trained in asking difficult questions, they have signed confidentiality documents and part of our team. Their role is paramount to provide health services to our patients.
How quick will you respond?
- We use a traffic light system to highlight the more urgent problems. The online software helps to facilitate this.
- We will respond to urgent problems the same working day.
- Routine requests will be managed within 2 working day (although it will often be the same day it has been sent to us).
How quick will you respond?
- We have different ways, but it will usually be one of the following:
- Email or Text message responses.
- Self-book links to make appointments.
- Telephone calls if deemed necessary.
Do all appointments have to be booked this way?
- No, appointments for our nursing team are mainly managed over the phone. This will be particularly relevant for annual reviews, blood tests, wound management.
Why can’t I just book an appointment like I used to?
- Nationally, GP capacity can no longer meet the demand and so we must put systems in place to ensure our patient gets the most appropriate safe care.
- Health care is evolving, and we need to embrace this.
Isn’t this ageist?
- No – the majority of our more senior patients have access to the internet or smart phones and are quite capable of using the simple online system.
- We are planning to use our care co-ordinators at the practice to support anyone who needs a bit of extra help in the early days.
What about vulnerable patients or those with special needs?
- We work hard to identify our patients who may need extra help and can flag this on medical records.
- If someone is struggling to navigate the system, we will support in any way we can.
What types of GP appointments are there?
- We have several different sorts of appointments which we can triage patients into. These include:
- Routine – these are for non-urgent problems. Waiting times vary but are currently 2-5 weeks depending on individual GP availability.
- Urgent – these tend to be ‘on the day’ or ‘next working day’ appointments. These are shorter appointments to manage only 1 acute problem.
- Priority – these are our semi-urgent appointments released 5 days in advance.5 minute skin lesion – these are quick (5 minute) appointments for moles / single skin lesions.
- Telephone slots – many things can be managed conveniently and safely over the phone. We will usually give a 2 hour window for this call.
Who else might I be asked to see?
- Not every health problem needs a GP – over the last 5 years we have significantly expanded our team.
- Pharmacists – We have our own highly trained clinical pharmacists and technicians at the practice who manage all our blood pressure patient as well as complex medication issues.
- First Contact physiotherapists – our team see all muscular-skeletal problems. They will see and assess the problem and come up with a plan. This may include further tests, referrals and they link directly with the hospital.
- Mental Health Workers – we are lucky to have 2 experienced clinicians who see patients to assess and help manage most mental health conditions.
- Social prescribers – our team help patient where they may have a social problem or health problems linked with social situations. They can see patients and families at the practice or sometime at home.
- Nurses – our experienced nurse team manage many conditions.
- Community Pharmacies – a new program called ‘Pharmacy First’ has been set up to treat several minor conditions and they can prescribe antibiotics where appropriate.
- Community Eye service – most eye conditions are managed by this team and they link in with local optometrists.
- Dentist – we are not able to manage any dental problems (even for emergencies) – if you don’t have your own dentist, please ring 111 for advice on accessing care.
- Self-care – many conditions can be managed with advice and support.
Can I choose what time I come for an appointment?
- For routine appointments, we will give as much flexibility as possible (subject to availability).
- For urgent appointments, we expect patients to be flexible and will likely be asked to attend at any time between 8-6 subject to what we can offer. We do NOT have flexibility on these.
- For urgent health problems, employers are legally expected to allow employees to attend these (including at short notice).
Why can’t I send a request when you are shut?
- Primary care remains a Monday to Friday, 8-6pm service. There are other services available for urgent problems outside of this time.
- We are considering the best times to open the service and may open it a bit earlier to help with work flow.
- We have to manage demand on the practice – our practice team work hard but also need to work within safe working conditions.
What happens if you are full?
- We have carried out a lot of work looking at demand management and try to respond to predicted fluctuations in workflow.
- We have to remain safe – there has been a lot of concern about clinicians being overwhelmed by work stress and demand. This leads to sickness and reductions in service.
- There will be times when the work demand will exceed capacity, in this situation, we will have to turn off the online system. In this case, if the problem is urgent, you will need to contact 111 directly or send a request the next working day.
In the past I tried to use the online system, but it said to ring the practice, will this still happen?
- This will not happen very often at all. We will be removing most of those blocks to allow consultations to come through to the practice. Flags will be automatically put on the online request to highlight the ‘more serious symptoms’.
- If you have symptoms suggestive of a medical emergency, you will be signposted to go to A+E – in this situation, please do NOT ring the practice as our team will also signpost you there.
Why does it ask so many questions?
- The questions have been developed nationally to get enough information to make safe clinical decisions.
- The average online consultation will take less than 5 minutes to complete.
Can I email the practice?
- The practice has never promoted emails from patients as there is not a safe timely system to manage these. Unfortunately we have had examples of patients emailing late at night with ‘serious symptoms’ that needed immediate medical attention.
- We will not be offering a direct email address for clinical care.
How will I make an appointment if I need one?
- Once you have completed the online consultation, we can then assess what is needed.
Can I choose which GP I want to manage my problem?
- One of the questions asks if you have someone you would prefer to manage your condition.
- It will depend who is working that clinical day doing the triage.
- If a non-urgent appointment is needed, you will be able to choose which GP you wish to see (subject to appointment availability).
Can I choose which GP I want to manage my problem?
- One of the questions asks if you have someone you would prefer to manage your condition.
- It will depend who is working that clinical day doing the triage.
- If a non-urgent appointment is needed, you will be able to choose which GP you wish to see (subject to appointment availability).
Will this help the telephone system?
- We recently upgraded our telephone system to include a call back service which has worked very well.
- We hope if more patients use the online system, it will significantly reduce waiting times on the phone for those who need to call for other reasons.
How can I ask a general question about this new system?
- Please email the practice on [email protected] or write in and make it clear it is a question about Total Triage.
- We will collate the questions and answer as many as possible on this forum.
- Please don’t sent any clinical questions/ personal questions about your own health.